Browse > Article
http://dx.doi.org/10.3340/jkns.2013.53.4.223

Surgical Outcomes and Complications after Occipito-Cervical Fusion Using the Screw-Rod System in Craniocervical Instability  

Choi, Sung Ho (Department of Neurosurgery, Gachon University, Gil Hospita)
Lee, Sang Gu (Department of Neurosurgery, Gachon University, Gil Hospita)
Park, Chan Woo (Department of Neurosurgery, Gachon University, Gil Hospita)
Kim, Woo Kyung (Department of Neurosurgery, Gachon University, Gil Hospita)
Yoo, Chan Jong (Department of Neurosurgery, Gachon University, Gil Hospita)
Son, Seong (Department of Neurosurgery, Gachon University, Gil Hospita)
Publication Information
Journal of Korean Neurosurgical Society / v.53, no.4, 2013 , pp. 223-227 More about this Journal
Abstract
Objective : Although there is no consensus on the ideal treatment of the craniocervical instability, biomechanical stabilization and bone fusion can be induced through occipito-cervical fusion (OCF). The authors conducted this study to evaluate efficacy of OCF, as well as to explore methods in reducing complications. Methods : A total of 16 cases with craniocervical instability underwent OCF since the year 2002. The mean age of the patients was 51.5 years with a mean follow-up period of 34.9 months. The subjects were compared using lateral X-ray taken before the operation, after the operation, and during last follow-up. The Nurick score was used to assess neurological function pre and postoperatively. Results : All patients showed improvements in myelopathic symptoms after the operation. The mean preoperative Nurick score was 3.1. At the end of follow-up after surgery, the mean Nurick score was 2.0. After surgery, most patients' posterior occipito-cervical angle entered the normal range as the pre operation angle decresed from 121 to 114 degree. There were three cases with complications, such as, vertebral artery injury, occipital screw failure and wound infection. In two cases with cerebral palsy, occipital screw failures occurred. But, reoperation was performed in one case. Conclusion : OCF is an effective method in treating craniocervical instability. However, the complication rate can be quite high when performing OCF in patients with cerebral palsy, rheumatoid arthritis. Much precaution should be taken when performing this procedure on high risk patients.
Keywords
Atlanto-occipital joint; Postoperative complications; Cerebral palsy; Rheumatoid arthritis;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Ding X, Abumi K, Ito M, Sudo H, Takahata M, Nagahama K, et al. : A retrospective study of congenital osseous anomalies at the craniocervical junction treated by occipitocervical plate-rod systems. Eur Spine J 21 : 1580-1589, 2012   DOI
2 Fehlings MG, Errico T, Cooper P, Benjamin V, DiBartolo T : Occipitocervical fusion with a five-millimeter malleable rod and segmental fixation. Neurosurgery 32 : 198-207; discussion 207-208, 1993   DOI
3 Grob D, Dvorak J, Panjabi MM, Antinnes JA : The role of plate and screw fixation in occipitocervical fusion in rheumatoid arthritis. Spine (Phila Pa 1976) 19 : 2545-2551, 1994   DOI
4 Hong JM, Lee SG, Park CW, Yoo CJ, Kim WK : Tuberculosis of the craniovertebral junction with basilar impression : a case report. Korean J Spine 7 : 103-106, 2010
5 Grob D, Schutz U, Plotz G : Occipitocervical fusion in patients with rheumatoid arthritis. Clin Orthop Relat Res : 46-53, 1999
6 Haher TR, Yeung AW, Caruso SA, Merola AA, Shin T, Zipnick RI, et al. : Occipital screw pullout strength. A biomechanical investigation of occipital morphology. Spine (Phila Pa 1976) 24 : 5-9, 1999   DOI
7 Heidecke V, Rainov NG, Burkert W : Occipito-cervical fusion with the cervical Cotrel-Dubousset rod system. Acta Neurochir (Wien) 140 : 969-976, 1998   DOI
8 Hsu YH, Liang ML, Yen YS, Cheng H, Huang CI, Huang WC : Use of screw-rod system in occipitocervical fixation. J Chin Med Assoc 72 : 20-28, 2009   DOI
9 Jung JW, Lee SG, Kim IC, Yoo CJ, Kim WK, Park CW : A survived traumatic Atlanto-Occipital Dislocation. Korean J Spine 4 : 62-66, 2007
10 Kim IS, Hong JT, Jang WY, Yang SH, Sung JH, Son BC, et al. : Surgical treatment of os odontoideum. J Clin Neurosci 18 : 481-484, 2011   DOI
11 Kim KN, Park KS, Kim HW, Chung CK : Progressive quadriparesis following a minor trauma in a patient with Klippel-Feil syndrome : case report. J Korean Neurosurg Soc 31 : 192-194, 2002
12 Klimo P Jr, Kan P, Rao G, Apfelbaum R, Brockmeyer D : Os odontoideum : presentation, diagnosis, and treatment in a series of 78 patients. J Neurosurg Spine 9 : 332-342, 2008   DOI
13 Lal AP, Rajshekhar V, Chandy MJ : Management strategies in tuberculous atlanto-axial dislocation. Br J Neurosurg 6 : 529-535, 1992   DOI
14 Paquis P, Breuil V, Lonjon M, Euller-Ziegler L, Grellier P : Occipitocervical fixation using hooks and screws for upper cervical instability. Neurosurgery 44 : 324-330; discussion 330-331, 1999   DOI
15 McAfee PC, Cassidy JR, Davis RF, North RB, Ducker TB : Fusion of the occiput to the upper cervical spine. A review of 37 cases. Spine (Phila Pa 1976) 16 (10 Suppl) : S490-S494, 1991   DOI
16 Motosuneya T, Hirabayashi S, Yamada H, Sakai H : Occipitocervical fusion using a hook and rod system between cervical levels C2 and C3. J Clin Neurosci 16 : 909-913, 2009   DOI
17 Oda I, Abumi K, Sell LC, Haggerty CJ, Cunningham BW, McAfee PC : Biomechanical evaluation of five different occipito-atlanto-axial fixation techniques. Spine (Phila Pa 1976) 24 : 2377-2382, 1999   DOI
18 Riel RU, Lee MC, Kirkpatrick JS : Measurement of a posterior occipitocervical fusion angle. J Spinal Disord Tech 23 : 27-29, 2010   DOI
19 Sakou T, Kawaida H, Morizono Y, Matsunaga S, Fielding JW : Occipitoatlantoaxial fusion utilizing a rectangular rod. Clin Orthop Relat Res : 136-144, 1989
20 Sasso RC, Jeanneret B, Fischer K, Magerl F : Occipitocervical fusion with posterior plate and screw instrumentation. A long-term follow-up study. Spine (Phila Pa 1976) 19 : 2364-2368, 1994   DOI
21 Shen FH, Samartzis D, Jenis LG, An HS : Rheumatoid arthritis : evaluation and surgical management of the cervical spine. Spine J 4 : 689-700, 2001
22 Smith MD, Anderson P, Grady MS : Occipitocervical arthrodesis using contoured plate fixation. An early report on a versatile fixation technique. Spine (Phila Pa 1976) 18 : 1984-1990, 1993   DOI
23 Vender JR, Houle PJ, Harrison S, McDonnell DE : Occipital-cervical fusion using the Locksley intersegmental tie bar technique : long-term experience with 19 patients. Spine J 2 : 134-141, 2002
24 Wertheim SB, Bohlman HH : Occipitocervical fusion. Indications, technique, and long-term results in thirteen patients. J Bone Joint Surg Am 69 : 833-836, 1987   DOI
25 Spierings EL, Braakman R : The management of os odontoideum. Analysis of 37 cases. J Bone Joint Surg Br 64 : 422-428, 1982
26 Vaccaro AR, Lim MR, Lee JY : Indications for surgery and stabilization techniques of the occipito-cervical junction. Injury 36 Suppl 2 : B44-B53, 2005
27 Yoon SM, Park CW, Yoo CJ, Kim WK, Lee SG : Kippel-Feil syndrome associated with various anomalies in the cervical spine. Korean J Spine 4 : 232-235, 2007
28 Clark CR, Keggi KJ, Panjabi MM : Methylmethacrylate stabilization of the cervical spine. J Bone Joint Surg Am 66 : 40-46, 1984   DOI
29 Abumi K, Takada T, Shono Y, Kaneda K, Fujiya M : Posterior occipitocervical reconstruction using cervical pedicle screws and plate-rod systems. Spine (Phila Pa 1976) 24 : 1425-1434, 1999   DOI
30 Behari S, Nayak SR, Bhargava V, Banerji D, Chhabra DK, Jain VK : Craniocervical tuberculosis : protocol of surgical management. Neurosurgery 52 : 72-80; discussion 80-81, 2003
31 Boden SD, Dodge LD, Bohlman HH, Rechtine GR : Rheumatoid arthritis of the cervical spine. A long-term analysis with predictors of paralysis and recovery. J Bone Joint Surg Am 75 : 1282-1297, 1993   DOI
32 Carlson GD, Bohlman HH : Surgical techniques for occiput to C2 arthrodesis in Dillin WH, Simeone FA (eds) : Posterior Cervical Spine Surgery, ed 3. Philadelphia : Lippincott-Raven Publishers, 1998
33 Clark CR, Goetz DD, Menezes AH : Arthrodesis of the cervical spine in rheumatoid arthritis. J Bone Joint Surg Am 71 : 381-392, 1989   DOI
34 Clements WD, Mezue W, Mathew B : Os odontoideum--congenital or acquired?--that's not the question. Injury 26 : 640-642, 1995   DOI
35 Deutsch H, Haid RW Jr, Rodts GE Jr, Mummaneni PV : Occipitocervical fixation : long-term results. Spine (Phila Pa 1976) 30 : 530-535, 2005   DOI